Tuesday, June 7, 2011

Singapore hospital bed crunch....again....and again and again

So Singapore is suffering from a hospital bed crunch? Again? Rightly it has been described as a perennial problem. Dr Jeremy Lim last year alluded to it being a 'systems problem'. Of course it is. Like the floods hitting us nowadays, it is a systems problem. When rainfall exceeds a certain rate, the drains must overflow. Likewise, if there are more patients needing beds than there a beds, there will be a crunch. And patients get to sleep in corridors.

When I was a houseofficer, this was a fairly common occurence during every admitting day.

The question is why has this problem not been solved? It is not as if the problem is unknown. Or cannot be predicted. At least for the flood problem we can always blame the vagaries of weather .... global warming etc. But patient bed demands are fairly predictable through the year. Population growth numbers are very well known...at least to government departments. Surely bed demands can be computed and modelled. To me, a bed crunch is a sad indictment of the lack of MoH resolve in tackling this problem.

There was once a model that promised to deliver at least 80% of capacity for local patients, and only 20% was to be for the servicing of medical tourists. Yet the current figures suggest that medical tourists now occupy 30% of bed capacity. Surely this discrepancy can be modelled and provided for. The problem did not spring up overnight!

Another problem relates to the unbalanced provision of beds. Bed occupancies differ in the different hospitals. SGH and NUH has much lower occupancies than TTSH and CGH, and the latter therefore suffer worse bed crunches. Has the MoH over provided for the premier hospitals and inadequately for those servicing residents.

7 comments:

Anonymous
said...

It appears that the MOH probably can't handle this job, despite the X million dollar minister at the helm! So, just like the flooding problem, the ministry probably has to spend more millions to set up a committee made up of LOCAL and FOREIGN EXPERTS to study and project the short term and medium term hospital bed requirements.

Giga, I think one can't be 100% accurate in forecasting bed needs and bed crunch would be a perennial problem no matter how much money we throw at it.

Reason: patients and their individual circumstances are dynamic; so are illnesses and their treatments; even the attending doctors.

One answer may be more home-nursing care as well as community care, so that patients can be discharged faster? Expand the reach of Home Nursing Foundation? State to co-pay cost of private nurses making home calls? Or hospitals to have a dept of nurses who make house calls?

I shudder at the thought of building more hospitals because in order to justify their sunk and recurrent costs, more pple might have to be psyched into thinking they are sick, via screening and tests, and so the vicious circle continues :(

AuntieL,Actually you can model with some accuracy. I am not talking about predicting down to the final 1% bed occupancy, but in general , the levels of bed demand. This will take into consideration the demographics and rate of population growth, the expected numbers due to medical tourism and seasonal effects. Obviously if there is an epidemic, the numbers will be temporarily off, but by and large, you can predict the level of demand for hospital beds.

The Ministries have all these numbers, but the trouble is they never do their modelling seriously. What is disappointing is that the Ministries don't seem to be talking to each other, and so it seems like the rate of population growth took everyone by surprise. How can this be? Or that the level of demand due to medical tourism took everyone by surprise. Unbelievable!

If the MoH did the modelling and took the numbers seriously, they would know how to project demand and to cater for the increased demand appropriately.

As it is, it appeared, they stacked up capacity in the major hospitals for high-end needs for medical tourism and catered less community needs at peripheral hospitals. Too many private beds, and far too few subsidized beds. Should the re-structured hospitals invest so much in catering to private patients and medical tourism? Who will then look after the small people in the community?

Will the Gordian knot be untied? If the best health Minister ever could not solve the long-standing evolving problem,what is the hope for the future? (www.channelnewsasia.com/stories/singaporelocalnews/view/.../.html),